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BILL. OF LADING <br /> 3909 Park Road, Suite D. <br /> Benicia,CA 94510 <br /> NVIRONMENTAL SERVICES . <br /> GROUP 1 (877) 748-3040 <br /> Western Region <br /> DELIVERY DATE <br /> SHIPPER/CUSTOMER POINT OF CONTACT <br /> %DDRESS PHON8-# <br /> CITY,STATE,ZIP ,- <br /> BARRIER/TRANSPORTER PHONE# <br /> r <br /> T <br /> 3 ' L I,., <br /> CONSIGNEE/FACILITY POINT OF CONTACT - <br /> 4DDRESS PHONE# <br /> CITY,STATE,ZIP <br /> Y <br /> B <br /> C <br /> D <br /> Special Handling Instruction and Additional Information: <br /> #) WASTE R11,10 <br /> . YP110,1au ML fl_ .e. ®E` le' 1140C" Q00 <br /> Q0a <br /> Placards Provided YES NO Emergency Phone#(877)748-3040 <br /> SHIPPER'S CERTIFICATION:i hereby declared that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled;and are in all respects in proper condition for transport by highway,vessel,and rail according to applicable international and national government regulations. <br /> (SHIPPER)PRINT OR TYPE NAME ' _ = _. -SIGNATURE ~' = MONTH DAY YEAR <br /> (CARRIERn-RANSPORTER)PRINT OR TYPE NAME { SIONAtdkeMONTH DAY YEAA <br /> X x a i.lj 1 R A F <br /> (CONSIGNEE/FACILITY)PRINT OFJYPE NAME SIGNATURE MONTH DAY YEAR <br /> X / f. X <br /> 'orm#PSC-201-RV 6/04 <br /> PILE <br />